Myanmar’s women desperate for health care after decades of government neglect

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MAE SOT, Thailand — Maw Lwin Khine lives with her husband in a small wooden home with a thatch roof. They don’t have electricity, running water or a phone. The couple sells flowers, earning roughly 2,500 kyats (US$3) a day.

They were managing fine until Maw Lwin Khine, eight months pregnant, went into labor.

Maw Lwin Khine’s aunts packed up food, loaded her into a horse cart and took her to a hospital in eastern Myanmar’s Karen State. Her husband followed on a bicycle. At the hospital, the doctor determined that Maw Lwin Khin, 28, had high blood pressure and needed a Caesarian section. The doctor performed the operation, but the baby had already died.

The difficulties did not end there.

The government-run hospital charged 200,000 kyats for the operation and another 300,000 for medicine and supplies. The couple pulled together their life savings and borrowed the rest – about 455,000 kyats – from friends.

Two weeks later, Maw Lwin Khine became sick again. She had a high fever and her body swelled up. The couple couldn’t afford to return to the hospital. Instead, they decided to visit a clinic in neighboring Thailand that offers free health care and serves Burmese. They borrowed 26,000 kyats and traveled 11 hours to Mae Sot, a border town in Thailand.

Recent news coverage of Myanmar has focused on promising developments in this long-suffering nation: the nascent political reforms, the election of Nobel laureate Aung San Suu Kyi to parliament, and the West’s suspension of sanctions.

However, little attention has been paid to a more immediate need: affordable, decent health care.

Thanks to restrictive policies and a lack of investment, Myanmar’s current health care system is a disaster. Patients like Maw Lwin Khine are so desperate for affordable, quality medical attention that they travel long distances to cross an international border to get it.

“We had no money left so we decided to come here,” Maw Lwin Khine said at Mae Tao Clinic. Her cheeks looked puffy, her lips swollen and her eyes heavy with exhaustion. Yet she said she felt better. She said she has received good care, and for free.

Half of the patients at Mae Tao Clinic, which began as one house in 1989 and now spreads over a large compound and serves more than 100,000 people a year, come from inside Myanmar, also known as Burma. The other patients are Burmese migrants living in Thailand.

“Word of mouth in Burma has brought so many women from such far places because they’re desperate,” said Meredith Walsh, who for the past five years has worked at the clinic as a reproductive health technical advisor. She said she has seen patients come from as far as Rakhine State in western Myanmar.

The military junta that ruled the country for a half century spent very little on health care — roughly 2 percent of GDP in 2009, according to the World Health Organization. By comparison, the United States spent eight times more of its GDP. Neighboring Thailand spent more than double.

The international community has donated limited resources to Myanmar because of difficulties ensuring the money gets into the right hands.

“Relative to its population and income, Burma is one of the world’s smallest recipients of international assistance,” economist Joseph Stiglitz wrote during a trip to Yangon in March.

In addition to resources, the government restricts where and how aid organizations can operate, blocking the delivery of medical services.

The result has been a health care system that in conflict areas, does not exist, and in large cities, is too expensive for ordinary people, according to experts inside Myanmar and on the Thai border.

Health during conflict

Since Myanmar gained independence from the British in 1948, it has been wracked by armed conflicts and fragile ceasefires with civilians and ethnic rebels. In areas that are disputed or that have fragile ceasefires, services are extremely limited, according to Human Rights Watch senior Asia researcher David Mathieson.

During fighting, the army has even destroyed clinics, Mathieson said, sending mortar rounds into a village to disperse residents before destroying all civilian infrastructure including health facilities.